12.5 Medications for Neurological System Flashcards
Migraine Prevention Medication
- Beta-blockers/Calcium Channel Blockers
- TCAs (Tricyclic, Tetracyclic, Antidepressants)
- Antiepileptic medication
Migraine Treatment Medications
5-HT Receptor Agonist (Triptans)
- Sumatriptan (first line of defense to terminate migraine attacks. Relieves headache, nausea, photophobia and phonophobia - sensitive to sound)
Others
- Almotriptan
- Frovatriptan
- Naratriptan
- Rizatriptan
- Zolmitriptan
Route - PO, Nasal, Inhalation, SC
Action - Stimulates 5-HT1B/1D receptors on sensory nerves of trigeminal vascular system which causes vasoconstriction of intracranial vessels and suppresses the release of CGRT (which decreases inflammation and release of inflammatory neuropeptides)
Adverse Effects
- Heavy arms or chest pressure
- Vertigo, malaise, fatigue, tingling
- CORONARY VASOSPASMS IS IMPORTANT SO MONITOR ECG
Contraindications
- People with history of CAD or MI
- Pregnancy
- People who are at CAD risk such as post-menopausal women, smokers, over age 40, obesity, DM, dyslipidemia
Ergot Alkaloids
- Ergotamine
- No known mechanism of action
- Used to stop ongoing migraines and cluster headaches
Adverse Effects
- ERGOTISM (EXTREME PERIPHERAL VASOCONSTRICTION, PALLOR, COLD, NUMBNESS, MUSCLE PAIN, AND GANGRENE)
Contraindicated
- Hepatic/Renal Impairment
- CAD/PVD
- CAN CAUSE ADDITION, WITHDRAWAL WILL CAUSE MIGRAINE SYPMTOMS.
Nursing Implications for Migraine Meds
- Assess sensitivity
- HR and BP
- Have patient rest quietly in a room for 2-3 hours after drug intake
- Avoid smoking and exposure to cold
- Avoid driving
- KEEP TRACK OF TRIGGERS
- Take medication at first sign of migraine
- Take antiemetics if prescribed PRIOR TO ANTIMIGRANIE DRUGS
Parkinson’s
- Causes dopamine/acetylcholine imbalance.
- Dopamine inhibits neurons that produce GABA
- Acetylcholine excites GABA
- GABA impairs movement so too little dopamine and too much acetylcholine causes unopposed GABA stimulation which causes impaired movement.
- The cause of Parkinson’s may be accumulation of protein (alpha-synclein)
- This is what causes Lewy Bodies found on autopsy of PD patients.
Parkinson Medications
- Dopaminergic Agents
- Anticholinergic Agents
- DOES NOT ALTER DISEASE PROGRESSION (EXCEPT SELEGILINE)
Dopaminergic Medications
- Increases dopamine levels
- Levodopa (prototype)
- Promotes synthesis of dopamine in striatum
- Prolonged use can cause disabling dyskinesis (involuntary movements)
- Benefits diminish over time
MAO-B Inhibitors
- Inhibits a chemical that breaks down dopamine (which increases available levels)
- Used for initial treatment of Parkinson’s
Examples (-giline)
- Rasagiline
- Selegiline (can slow progression of disease for 12-24 months)
- Zelepar is an oral disintegrating form for people who have trouble swallowing
Dopamine Agonist
- Activates dopamine receptors
- Less effective but less chance of dyskinesia
- Intolerable for patients 70+
Examples
- Bromocriptine
- Pergolide
- Pramipexole
- Ropinirole
- Rotigotine
COMT Inhibitors
- Inhibit enzymes that degrade dopamine in the periphery
- Tolcapone
- Entacapone
Anticholinergics
- Blocks acetylcholine receptors
- Blocks muscarinic receptors which reduces acetylcholine release.
- Benztropine
- Diphenhydramine
- Trihexyphenidyl
Carbidopa-Levodopa (Sinemet)
Levodopa
- Turns to dopamine
Carbidopa
- Inhibits metabolism of dopamine in the intestines and periphery.
Contraindications
- Tetrazine (yellow dye) allergies
- Malignant melanoma
- MAOI’s in the past 14 days
- Breast feeding
Caution
- Heart Issues
Adverse Effects
- Weight loss, Dyskinesias, Postural hypotension psychosis (often), nightmares
- CAN ACTIVATE MALIGNANT MELANOMA
- MAOI’s WITH THIS MEDICATION CAN CAUSE HYPERTENSIVE CRISIS
Epileptic Medications
Controls Seizures By
- Altering sodium channels on cell membranes which limits spread of seizure activity
- Decreases calcium influx
- Enhances concentration of GABA (restores balance between excitatory and inhibitory neurotransmitters)
- THESE ARE CNS DEPRESSANTS (DO NOT DRINK ALCOHOL)
- WITHDRAWAL CAN CAUSE STATUS EPILEPTICUS (lasts longer than 5 minutes or more than 1 seizure in 5 minutes)
ADMINISTRATION
- Start at low dose and gradually increase until seizure is controlled.
- LIFELONG MEDICATION
Examples of AEDs
Traditional
- Phenobarbital
- Phenytoin
Newer
- Gabapentin
- OXCARBAZEPINE
- LAMOTRIGINE
Traditional is cheaper but more side effects and drug interactions
Newer is more expensive but better tolerated and fewer interactions
Drugs that Potentiate GABA
Barbiturates
- Phenobarbital
Benzodiazepines
- Diazepam, Clonazepam, Lorazepam
Misc.
- Gabapentin
- Primidone
- Tiagabin
